Provider Demographics
NPI:1841421013
Name:TRUDY MOON EISEL, D.C., P.A.
Entity Type:Organization
Organization Name:TRUDY MOON EISEL, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-261-1387
Mailing Address - Street 1:1190 PINE RIDGE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8914
Mailing Address - Country:US
Mailing Address - Phone:239-261-1387
Mailing Address - Fax:239-263-8780
Practice Address - Street 1:1190 PINE RIDGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-8914
Practice Address - Country:US
Practice Address - Phone:239-261-1387
Practice Address - Fax:239-263-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN164AOtherPTAN
FLCN164AOtherPTAN